…you can’t remember it

The best ways to communicate with older adults

By Dr. Michael Gordon

I see one of these cases at least once a month in my geriatric office practice. The referral from the family doctor requests that I do an evaluation to exclude the possibility of dementia. The family accompanying the older patient is sure their loved one has Alzheimer’s disease or some other form of dementia.

If a medical resident is going to see the patient first, which is often the case in my teaching clinic, I usually forewarn the resident to pay special attention to how the patient interacts with others. There are certain characteristic patterns of interaction that I watch for when there are cognition issues, as opposed to other confounding factors such as impaired hearing.

I discovered the relationship between hearing impairment and supposed cognitive decline early in my practice. I still see patients for whom loss of hearing plays a role in their ability to process information (one of the hallmarks of cognitive impairment or dementia). Clues to this often come from the family as they explain their concerns, which may include the nature of the forgetfulness and under what circumstances it happens—for example, if there are problems with talking on the phone and the older person does not seem to remember things during the conversation. If there is no amplification system on the phone, this is a clue that hearing may be playing a bigger role.

Another clue may come during an actual clinical interview. When I observe the family member talking to the patient from the side, there is sometimes a limited or delayed response. When I ask a question facing the patient and making sure that he or she can see my face and read my lips while I am speaking slowly and clearly, there is often a marked difference in the reaction of the patient to the same interaction or question.

The last clue or trick that I have is providing the patient with a simple external amplifier in the office while we are talking. We can then see if the response to my questioning improves. As an aside, the one I use was from Kmart many years ago when they were closing down one of their stores; these particular models were going for $10. Other than changing the earphones and batteries, it still works and has been instrumental in helping me diagnose hearing loss.

I have used the same device—and more recently the more sophisticated and modern Pocketalker—with my father. He has had severe hearing impairment for many years and for myriad reasons rejected the use of hearing aids. With his more recent decline in cognition, my sister and I decided to try a Pocketalker with him. Although I wish I could say the effect was overwhelmingly dramatic, which I cannot, there is no question that he was more responsive to conversation with it than without. Even with a minor degree of improvement we felt it was worthwhile.

The message is this: Before attributing all cognitive decline or impairment to problems inherent in the brain, make sure you check that a person’s ability to hear is as good as it can be. A full assessment by an audiologist is key to achieving this goal.

Dr. Michael Gordon is Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System and co-author of Parenting Your Parents: Straight Talk About Aging in the Family.